Effective July 1, 2022, BCBSRI will require the National Drug Code (NDC) to be filed on all claims submitted with a drug HCPC/CPT code. When filing an NDC # on your claim, it must be in an 11-digit format. Failure to provide the NDC # on your claim or not provide the entire 11-digit code will result in your entire claim being denied or removed from the system at your clearing house.
If a paper claim is filed to BCBSRI with no NDC # on the claim – BCBSRI will accept the claim, however the entire claim will be denied on your provider RA with a denial reason code which reads: “x56 The National Drug Code is required when filing with a Drug HCPC/CPT Code.”
If a paper claim is filed to BCBSRI with an NDC # that is not valid (e.g., 10 digits instead of 11) – Your entire claim will be rejected, and a letter will be sent to you indicating the NDC # was invalid on your claim.
If your claim is filed through electronic submission with no NDC # on the claim – Your entire claim will be rejected from your clearing house with a rejection code of “LINE PROC CD REQUIRES NDC.”
If your claim is filed through electronic submission with an invalid NDC # – Your entire claim will be rejected from your clearing house with a rejection code of “L326 - NDC Missing or Invalid.”
If a BCBSRI participating provider/facility is filing a claim for an out-of-area member, the NDC # is required on the claim for your claim to be reimbursed for the services. If a BCBSRI member sees an out-of-area provider, the NDC # is not required for that out-of-area provider, but we will accept the NDC # if it is on the claim.
A valid NDC # will be required for coordination of benefits claims where BCBSRI is the secondary carrier. If the primary carrier does not require the NDC #, you will need to provide the NDC # on your secondary claim submission for your entire claim to be paid.
If you have any questions regarding this requirement, please contact Provider Relations at ProviderRelations@bcbsri.org.
For reference: Payment Policy – Coding and Claim Filing Requirements for Drugs